Celiac.com 06/07/2016 - The world of nutrition is currently obsessed with "super foods". Super foods are loosely defined as foods that are extremely high in nutrients – particularly antioxidants and vitamins – and which everyone is heartily advised to add to their diet.

The problem with this approach is that, while focused firmly on nutrients, we are ignoring anti-nutrients! According to Wikipedia, an anti-nutrient is a compound in food that interferes with your absorption of other nutrients from a food. Most foods have varying amounts of anti-nutrients, toxins and other problematic compounds. A truly healthy diet will include weighing the good against the bad, while maintaining as much variety as possible. Once we have a clearer picture of how a food helps to support our nutrition, we can then decide how to include it in our diet and in what amount.

Obviously, certain health conditions mean that certain foods are no longer healthful. For those with celiac disease, this means that grains with gluten in them are damaging to their health. It really doesn't matter how healthy wheat bran is for some – for celiacs, wheat bran is harmful. For those with allergies, you have a similar issue. Foods that may be healthy for some may not be for others.

Another issue with food and health can be related to anti-nutrients. For instance, in the vegetarian world, we now hear more about phytate – often found in legumes – and how to reduce it in a plant-based diet. Salicylate is another anti-nutrient found in plant foods, and more people are finding that they need to consider this when choosing foods.

Plants may also contain toxins, which are totally natural to the plant, but not good for you. Wikipedia indicates that a toxin is a substance that is directly poisonous, and capable of causing disease. For instance, some foods may contain naturally occurring cyanide compounds, or even arsenic in various forms. While we may not get enough to cause immediate problems, we certainly don't want to consume a lot of these toxins!

Oxalate is another toxin present in many otherwise healthy foods. Oxalate poses many challenges for human health. It's a free radical. It promotes inflammation in your body. Because of its biochemistry, oxalate can be stored throughout your body, and can be particularly concentrated at the sites of previous injury, inflammation or surgery. Fundamentally, oxalate can be stored in tissues wherever the cells have taken it up. As a result, if you are someone who is absorbing too much oxalate from your diet, you can be contributing substantial stress to your body.

Reducing the amount of oxalate in your diet cannot hurt you – you are reducing a totally non-nutritive substance for which the human body has no need and which contributes directly to health issues.

However, reducing too many food types or nutrients in your diet can have negative impacts. The greater the variety in your diet, the better the chance that you are getting all your needed nutrients. The good news is that you can have a nutritious, high variety diet, and retain "super foods" in your diet which are high nutrition, gluten-free and low oxalate.

Get Your Fiber

The preponderance of processed foods in our diets can often leave us with hardly any fiber in our diet! Many gluten-free options are very low in fiber, and this can affect gut health. Fiber is not a direct nutrient for us per se – but it is a needed component that contributes to better gut flora and better health overall.

Insoluble fiber adds bulk to the stool and promotes regularity. Most of us are not getting enough of this fiber, and as a result, can develop poor motility and constipation.

Given that many whole grains are not good alternatives for those on a gluten-free diet, and the bran of many grains are actually high in oxalate, how can we get more healthy insoluble fiber? The good news is that one nutritional powerhouse is not only full of healthy insoluble fiber – it's also a plant source of Omega 3's. So a great solution to lack of insoluble fiber is flax seeds.

Flax seeds can be eaten whole – but to really get the best benefits from this super food, it's best to grind your flax. Keep whole flax seeds in the freezer to preserve their freshness, and don't grind until just before using them. The recommended daily serving (which will also provide some soluble fiber) is two tablespoons.

According to the Mayo Clinic, the right fiber goes much further than just regularity. If you increase soluble fiber, it can help reduce both blood sugar and cholesterol. Soluble fiber creates a gel-like material in the gut, and some research indicates that it may help to feed our gut bacteria.

The benefits of soluble fiber are well known when it comes to cholesterol. The recommended food to get more soluble fiber is oats. However, whole oats are high in oxalate, and the oat bran has confusing test data.

The solution? Psyllium! Pysllium is the medicinal ingredient in the popular product, Metamucil. Psyllium contains both soluble and insoluble fiber – and research on it shows that it can help to reduce cholesterol as well as normalize blood sugar. You can add it to baked products (but adjust the liquids), or sprinkle on foods. It's virtually tasteless – although you might find it does add some thickness or texture to liquids or foods.

Fruits and vegetables are also good sources of both soluble and insoluble fiber and many are lower oxalate. Cabbages, lettuces, onions, cucumbers (with the skin) red bell peppers, orange, mango and grapes are all good low oxalate sources of fiber in your diet.

Fruits

There is no shortage of healthy options in fresh fruits that are also low oxalate, but the blueberry holds a special place among even the healthiest fruits.

Research shows that blueberries are one of the most antioxidant rich foods available, and are included in most lists of super foods. Blueberries are one of the highest rated foods on the ORAC scale. The ORAC scale was developed by researchers at Tufts University, and is the measure of Oxygen Radical Absorbance Capacity (hence the abbreviation ORAC). What this really means for you is that the higher something ranks on the ORAC scale, the more antioxidants you are getting.

Blueberries are stars on this scale, with an ORAC value of 4,669 per 100 grams, according to Superfoodly.com. Wild blueberries rank higher than cultivated ones – but you can't go wrong with any blueberry.

Another fruit that ranks very high in ORAC is the lowly cranberry. While very tart (and difficult to eat raw), cranberries are second only to blueberries in antioxidant levels. To reduce the acidity of the fruit, and make them more palatable, cook with water and some honey. Cranberries are very easy to cook and make a lovely side dish for fattier meats like lamb. They aren't just for turkey anymore! Consuming these tangy fruits also help to contribute to bladder health.

For nutrition on the go, turn to golden seedless raisins. While dark raisins are tasty treats, the golden seedless variety is both lower in oxalate and higher in antioxidants. In fact, golden seedless raisins actually have a higher ORAC score than fresh blueberries! Combine that with convenience and portability, and you have an easy way to get more antioxidants in your day. Raisins also make a great treat for kids, because of their sweetness.

Is the apple a super food? Yes it is! Easy to purchase and pack for lunch, this popular fruit is full of quercetin, which protects cells from damage and is often recommended for those with allergies. Not only is it full of healthy antioxidants, it also has twice the fiber of other commonly eaten fruits, including peaches, grapes and grapefruit, according to the site EverydayHealth.com.

Veggies

When looking at veggies, many of the foods that are considered most healthy are also very high in oxalate. Everyone talks today about how healthy the sweet potato is for us: but did you know that a ½ cup of sweet potato can have over 90 mg of oxalate in it? For people trying to eat a low oxalate diet, a single serving would be more oxalate than they should consume in a whole day!

However, while avoiding high oxalate foods, you do need to eat color and variety to get your needed nutrition. If you want a lower carbohydrate, orange veggie – consider the kabocha squash. Not only does this lower carb, low oxalate veggie work as a substitute for many recipes that require sweet potato, it also has a very good nutrient profile. Self Nutrition Data lists Vitamin A and Vitamin C as well as a good serving of Folate, in addition to good amounts of calcium, magnesium, phosphorus and potassium.

Of course, you want other colors in your veggies as well – and green leafy veggies are particularly known for their nutrition. While spinach would be a bad choice because of extremely high oxalate, you have lots of other greens to choose from. Focus on lower oxalate varieties of kale, including purple kale. The website, The World's Healthiest Foods, lists kale as a food that can lower cholesterol (if steamed) as well as lower your risk of cancer. Of course, kale is part of the cruciferous vegetable family, and these foods have many anti-cancer benefits. Kale is an excellent source of Vitamin K (your blood clotting factor), as well as vitamin A, vitamin C, manganese, copper, B6 and others.

Don't forget your other brassicas while you are focusing on kale! The cruciferous veggies also support our bodies natural detox processes, which is very valuable in today's world where we are exposed to many environmental toxins. Broccoli is another low oxalate brassica that is good for you, whether you are eating the mature broccoli heads, or feasting on broccoli sprouts. Note that broccoli sprouts do have an edge over their more mature cousins – they might just taste better, and given that they can be added to a sandwich for some satisfying crunch, might be easier to work into your daily diet. Research gives the sprouts a further edge in cancer risk reduction and some research indicates they may actually help to prevent stomach cancer.

Another excellent leafy green is the lowly turnip green. Turnip greens are very high in calcium, and are even lower in oxalate than kale. A cup of cooked turnip greens will also get you more than 100% of the RDA for vitamin K. In addition, you'll get vitamin A, vitamin C, folate, copper, manganese, calcium, and vitamin E. Each serving will give you 15% of your daily requirement for B6.

When thinking of deep red veggies, go for red cabbage. This versatile veggie is very low in oxalate, and that lovely red color means that it has even more protective phytonutrients, according to World's Healthiest Foods, than its green sibling! One serving of red cabbage delivers more than four times the polyphenols of green cabbage.

Fats and Oils

You can't read on super food nutrition anywhere and not run into the avocado. A great source of healthy monounsaturated fat, the avocado has also been linked to reduced risk of cancer, as well as lowered risk of heart disease and diabetes. While we think of avocados as a fatty food, they are actually a good source of fiber, with 11 to 17 grams of fiber per fruit! You'll also get a dose of lutein, an antioxidant recommended for eye health.

Web MD says that lutein is a potent antioxidant, which is found in high concentrations in the eye. The combination of lutein and zeaxanthin (another antixodant) help to protect your eyes from damaging, high energy light. Some research indicates that a diet high in lutein and zeaxanthin may reduce the risk of cataracts by as much as 50%.

Coconut oil is another excellent fat that can benefit our bodies in a host of ways. Doctor Oz lists a number of benefits, including supporting thyroid health and blood sugar control. This may be related to the form of saturated fat that is found in coconut oil, called lauric acid. Lauric acid is a medium-chain triglyceride. This kind of fat actually boosts immune system, and has antibiotic, antiviral and antifungal properties. It may also be a tool in your weight loss arsenal. A study in 2009 actually showed the eating 2 Tablespoons of coconut oil daily, allowed subjects to lose belly fat more effectively. Even better news for those who are following a low oxalate diet: both avocado oil and coconut oil have zero oxalate!

Nuts, Seeds and Legumes

Unfortunately, many foods in this category are high oxalate – and so won't qualify for our super food list. While you might be able to have a couple of walnut halves, or a similar amount of pecans, nuts are generally just to high to have in servings of more than 3-5 pieces.

However, if you are looking for a superfood in this category, look no further than pumpkin seeds! Pumpkin seeds are an excellent source of vegetable-based protein, and are another portable food. A great snack for the health conscious can be made with raisins and pumpkin seeds – both are low oxalate, and the protein of the pumpkin seeds will help you to stay fuller longer. According to LiveStrong.com, a handful of pumpkin seeds will give you over 8 grams of protein. At the same time, pumpkin seeds are low in sugar, and provide you with fiber as part of the carbohydrate in them. You will also get vitamin A, vitamin B, vitamin K, thiamine, riboflavin, niacin, magnesium, calcium, iron, manganese, zinc, potassium, copper and phosphorus in that small and compact package!

If pumpkin seeds don't qualify as a super food, it's hard to say what would!

When it comes to legumes, many are stars for protein, but one of the best options is the red lentil. Lentils in general are easier to prepare than other types of legumes – they do not require the soaking and preparation time that many legumes do. At the same time, they are powerhouses of nutrition, with molybdenum, folate, fiber, copper, phosphorus and manganese all at more than 50% of your daily requirement. One cup of cooked lentils will also give you 36 % of your daily need for protein, according to World's Healthiest Foods. And all this nutrition is provided in a food that is virtually fat free and low in calories. You cannot go wrong!

As an added benefit, some studies have found that eating high fiber foods like red lentils may reduce the risk of heart disease. The more fiber, the lower the risk of heart disease.

Fish

We are always hearing that we need to have more fish in our diets. It seems sometimes that not a week goes by when we are not hearing that we should be eating less meat, and getting less fat – with the suggestion that more fish would benefit us.

When you think of the super food of fish, you have to think of salmon. Salmon is a fatty fish, and it's one of the best sources available for omega-3 fatty acids. In today's world of processed foods, omega-3's are one of the nutrients that we don't get enough of.

Your best bet with salmon is to get wild-caught fish. Farmed salmon do not have the same nutrient profile, which may be related to the kind of food they are fed. Along with the decreased nutrient profile, studies have indicated that farmed salmon contains significantly higher concentrations of a number of contaminants (including PCBs, dieldrins, toxaphenes, dioxins and chlorinated pesticides) than wild caught salmon.

World's Healthiest Foods states that a 4 ounce piece of Coho salmon will get you 55% of your daily requirements for omega-3 fats. On top of that, you'll get more than 50% of your daily requirement for vitamin B12, vitamin D, selenium, vitamin B3, protein and phosphorus, as well as other B vitamins and minerals.

Omega-3 fatty acids will provide you a host of benefits, from reduction of inflammation, to better brain function. Omega-3 fat is also heart healthy, and can contribute to a reduced risk of heart attack, stroke, high blood pressure and other cardiovascular disease. Research indicates that eating salmon at least 2 to 3 times a week will give you the best benefits.

Spice it up

Spices can be a bit tricky, if you want to keep your oxalate low. Many spices – while tasty – are very high in oxalate!

A great example of this is turmeric. A staple in most curry recipes, turmeric is extremely high oxalate – so while it has a reputation as a super food, it would not be a good choice if you are trying to keep your oxalate low.

So what is your option if you love to eat foods spiced with turmeric? Well, the easiest approach is to stock your spice rack with a health food store supplement; cook with curcumin extract! While it may seem a bit odd at first, if you buy a curcumin extract (which is the extract from turmeric), you can get the flavor and leave the oxalate behind.

While not technically a "food" when you cook with a supplement, you certainly get all the benefits of the original super food – turmeric – without the downside of oxalate.

Another highly beneficial spice is cinnamon. Research clearly shows how helpful cinnamon is for managing blood sugar. However, ground cinnamon is an extremely high oxalate spice. So how can you get the flavor you want, while avoiding the oxalate?

One solution is to cook with a cinnamon extract that you buy at the health food store! One brand known to be low oxalate is Doctor's Best. It is a dry extract in capsules – simply break open the capsules and use the contents in your dish. This allows you to get all the therapeutic benefits of the extract as well as the taste.

You can also cook with essential oils and culinary oils – but use them carefully. Essential oils can be very strong and can irritate the tissues of the mouth and digestive tract. One drop of good quality essential cinnamon oil will replace as much as 1 tablespoon of ground cinnamon. Culinary oils are made for flavoring – follow the directions on the product that you buy. Either way, you will get the taste – and you avoid the oxalate.

Enjoying Your Food!

As with anyone who wants to eat a healthy diet full of super foods, the trick is to focus on the best nutrition, and get lots of variety. While some foods may not be as "super" as others, if you are making colorful meals, with healthful selections from across the spectrum, you'll be doing your body a favor with flavor!

Where Does Oxalate Go?

Once you have eaten oxalate, you have to excrete it through urine, feces or sweat. But what happens if you don't? A study on rats was able to trace where in the body a dose of oxalate remained. The scientists used a special carbon molecule – carbon 14 – in the oxalate they gave to the rats, so that they could find the oxalate wherever it went in the body.

What they found is that if the oxalate was not excreted from the body, it was stored everywhere:

• 68% in the bones
• 9% in the spleen
• 8% in the adrenal glands
• 3% in the kidneys
• 3% in the liver
• 8% in the rest of the body

These results are in direct opposition to conventional medical thinking, that oxalate only affects the kidneys. It clearly shows us that the whole body – but particularly the bones, key glands and detoxification organs – are all affected. This is another good reason to reduce the amount of oxalate in your diet!

Is Spinach Really That Bad For You?

A relatively simple study in the late 1930's looked at rats fed a diet that was only adequate in calcium. To bring the levels of calcium up, the rats were given spinach, equaling about 8% of their diet. While most of us think of spinach in terms of iron, it is also relatively high in calcium. The results of the study were shocking:

• 47. A high percentage of rats died between the age of 21 days and 90 days
• 48. The bones of the rats were extremely low in calcium (despite adding it to the diet through the spinach)
• 49. Tooth structure was poor and dentine of the teeth poorly calcified
• 50. For these animals, reproduction was impossible.

Researchers concluded that not only did spinach not supply the needed calcium (because of the oxalate), but the spinach also rendered the calcium from other foods unavailable. What we know now is that oxalate is a mineral chelator – and rather than delivering minerals, it was robbing them from the rats.

Getting Your Vitamin K

Vitamin K is a very important nutrient. Life Extension indicates that new research from 2014 links vitamin K to longevity. In fact, the highest intakes of vitamin K reduced the likelihood of dying from any cause by 36%! So, you definitely want to get vitamin K in your diet.

However, most of us think that we need to eat high oxalate greens – like spinach – in order to get good amounts of vitamin K. Nothing could be further from the truth! Kale, collards and turnip greens are all higher in vitamin K than spinach, and they have a fraction of the oxalate.

Serves 6 to 8

Ingredients:

• ¼ cup extra-virgin olive oil
• ½ small onion, diced
• 2 medium carrots, peeled and diced
• 1 celery stalk, diced
• Sea salt and freshly ground black pepper, to taste
• 8 yellow, red and/or orange bell peppers, chopped
• 1 large sweet potato, peeled and chopped
• 4 cups low-sodium vegetable broth
• 3 teaspoon finely chopped fresh marjoram
• 1 recipe Gluten-Free Herbed Croutons, for garnish
• Sliced avocado, for garnish; optional
• Finely chopped fresh cilantro, for garnish; optional
• Drizzle Seriously Sensational Sriracha Sauce, for garnish; optional

Directions:
In a large pot, heat the oil over medium heat. Add the onion, carrot, celery, and a pinch of salt and black pepper. Cook until the vegetables are tender, about 4 minutes. Add the bell peppers and cook until soft, about 6 minutes. Add the sweet potatoes and broth. Season with salt and black pepper, cover the pot, and bring to a boil. Lower the heat and add the marjoram. Simmer until the vegetables are tender, about 20 minutes.

Let the soup cool slightly, and then, in batches, transfer to a blender and puree until smooth. If needed, thin the soup with water. Adjust the seasoning with salt and black pepper if necessary. Return the soup to the pot to keep warm until serving. Serve garnished with the Herbed Croutons and, if desired, the avocado and cilantro on top and Seriously Sensational Sriracha Sauce on the side.

Text excerpted from EATING CLEAN, © 2016 by AMIE VALPONE. Reproduced by permission of Houghton Mifflin Harcourt. All rights reserved.

Celiac.com 05/24/2016 - How many of us have suffered from cross contamination? Most celiacs have felt the side effects of getting gluten in their food. If it is not your own kitchen, utensils, pots or pans it can be a bit nerve racking. It is not only extremely unpleasant, but unhealthy to our intestines as well. It can cause damage that can be very detrimental in the long run.

This is exactly why the gluten-free label is particularly important. This gives celiacs a sense of safety, like a security blanket. However, how is that labeling decided upon? What certifications are really used? What standards are considered to ensure that it is 20 parts per million (ppm) or even less? Just think about the danger that can occur if something has to be recalled. For example, let's take a look at General Mills Cheerios versus Udi's Gluten-Free Foods.

Now, Udi's is certified by the Gluten Free Certification Organization (GFCO), which is an industry program of the Gluten Intolerance Group (GIG.) Whereas Cheerios, takes the oats, used to make the cereal, and puts it through a proprietary, mechanical system. This is supposed to remove any cross-contamination from wheat, barley or rye, according to General Mills. How safe is this for individuals with celiac disease? This is why standards are very vital.

Now, the GFCO requires that all finished products' ingredients, using their logo, contain 10ppm or even less of gluten. It requires a stringent review process, in order to gain approval. Plus, barley-based ingredients are absolutely not allowed, under any circumstances.

Then, you look at Cheerios and the differences are as plain as day. Recently, there was a major recall of 1.8 million boxes due to an error where a gluten ingredient was accidentally added. General Mills issued a recall of some Original Cheerios and Honey Nut Cheerios cereal because some boxes were labeled as gluten-free but actually contained wheat.

This is absolutely not safe for the celiac community. This improper labeling can be dangerous and there are no certifications or review processes like the GFCO. The thought of becoming ill from the cross-contamination is not on any celiac's to do list. Having certified oats versus regular oats is safer that simply having the wheat washed out. The oat fields are way too close to the wheat fields.

In the end, which would you rather purchase? There is Certified Gluten Free Foods versus just gluten-free foods. Think about your villi because they really should be up and not down!

References:

1. Udi's Gluten Free - FAQs. Retrieved from: Open Original Shared Link
2. Gluten Intolerance Group - The Gluten-Free Certification Organization. Retrieved from Open Original Shared Link
3. CNBC - General Mills recalls 1.8M Cheerios boxes for allergens. Retrieved from Open Original Shared Link
4. Gluten Free Living - Gluten-Free Cheerios. Retrieved from Open Original Shared Link

Celiac.com 05/17/2016 - The paleolithic diet, or paleo diet which happens to be gluten-free, has been growing increasingly popular among athletes and health advocates, but it has a history dating back to the mid-1970's as a means of preventing diseases and health conditions such as autoimmune diseases and cancer, when investigations were made of the eating patterns of our hunter-gatherer ancestors.

The paleo gluten-free diet, the "biologically appropriate" diet, is named for the Paleolithic era, which extended 2.5 million years ending in 10,000 B.C. with the advent of agriculture and animal husbandry. It's comprised of the foods our human ancestors consumed during this period, namely wild-caught fish, grass-fed meats, fruits, vegetables, roots, and nuts. Any "modern" foods introduced from the agricultural era forward such as grains, dairy, sugar, and processed foods are eliminated.

People all over have found the paleo gluten-free diet is an effective answer for weight loss, optimizing health and fitness—and building muscle tone. According to research, pre-agricultural humans were free of the diseases of the civilized world such as cardiovascular disease, cancer, obesity, and autoimmune diseases. Modern studies, including clinical studies, have shown as well that the paleo diet and the restoration of the lifestyle conditions of our ancestors, such as exercise, have resolved numerous diseases.

The theory behind the diet, supported by extensive archeological and anthropological evidence, is based on the premise that modern humans do best on paleolithic nutrition because human genetics have largely remained the same since the pre-agricultural era and thus our genetic makeup is best suited to the ancestral human diet.

If you're looking to build muscle tone, meet with a qualified health practitioner to see if the diet is for you. I think you'll find that whatever your reason for starting the paleo diet and lifestyle, whether to optimize your fitness routine, lose weight, alleviate autoimmune disease symptoms such as celiac disease, or increase your longevity, eating in the biologically appropriate way for our bodies not only has the power to change your body and your health, but your quality of life.

While many people are eating paleo gluten-free as a way to correct health conditions or improve their overall health, active individuals and athletes have been following the diet in order to lose fat and build muscle more efficiently, according to MuscleMag.

In fact, one of the best known proponents of the paleo diet, Robb Wolf, former biochemist and author of The Paleo Solution, regards the diet as performance-enhancing and trains world-class athletes at his gym in Chico, California.

According to Robb, our human ancestors were taller, leaner, and better built than humans now, as anthropological evidence shows us. According to MuscleMag, only during the last 10,000 years, since the advent of agriculture, have humans consumed grains, legumes and dairy—and during this same period, humans have also become "significantly shorter, fatter, less muscular and more prone to disease," as anthropological studies point out. Let's take a look at some of the reasons why the paleo gluten-free diet is optimum for building muscle tone.

The paleo gluten-free diet, consisting wholly of unprocessed foods like seafood, lean meat, fruits and vegetables, nuts and roots, is much more nutritious than the foods from the Neolithic era and beyond. The optimal nutritional intake on the paleo gluten-free diet is a vital part of developing muscle tone.

Although you'll hear grain advocates singing the praises of the fiber and B vitamin content of grains, you'll actually find more of these nutrients in grain-free foods, as long as you eat a variety of nutrient-rich whole foods. According to GrainFreeLifestyle.com, "If you can find the nutrient in grain, you can find the nutrient in better quantities in other foods." For example, 100 grams of whole wheat flour contains 44 mcg of folate, but a 100-gram serving of lamb liver yields 400 mcg of folate and a 100-gram serving of yard-long beans offers 658 mcg. Also, 100 grams of cooked brown rice has 1.8 grams of dietary fiber, whereas a 100-gram serving of cooked collard greens has 2.8 grams and green peas offer approximately 5 grams of fiber per serving.

In fact, grains that are poorly prepared, which is most often the case, can prevent the absorption of vitamins and minerals. Your diet may be rich in nutrients, but if it's also rich in improperly prepared grains, you won't be able to absorb them due to substances in grain such as phytic acid, which binds with minerals so you can't absorb them properly.

Gluten is a protein found in wheat, barley, and rye. The paleo diet is a naturally gluten-free diet because it is a grain-free diet. Studies show that 1% of the population has celiac disease, an autoimmune condition triggered by the ingestion of gluten, which causes the immune system to attack the lining of the digestive tract and inhibits the proper absorption of nutrients from your food.

But experts are saying that a large proportion of non-celiac individuals are suffering from gluten intake as well. Some researchers estimate that as much as 40% of the population is also sensitive or downright intolerant to gluten, which can lead to the same symptoms and conditions of celiac disease. Celiac disease and gluten sensitivity are severely undiagnosed, and it could be the case that you yourself have gluten issues.

Not only grains but other Neolithic and modern foods, such as legumes, dairy products, sugar, and processed oils can irritate the digestive tract as well. For example, legumes contain antinutrients such as lectins, saponins, and protease inhibitors, which cause damage to the intestines and hormonal and immune systems, leading to inflammation and increasing the risk of inflammatory and autoimmune diseases. All soy products and peanuts are actually classified as legumes and are to be avoided on the paleo gluten-free diet.

With intestinal inflammation, nutrient absorption is severely limited, especially when it comes to protein. Furthermore, the inflammatory response in the gut can spread throughout the body. This systemic inflammation can lead to the retaining of water as well as weakening the immune system, while a strong immune system is vital when it comes to recovering from intense exercise and building muscle.

Let's dive into how to get superior sources of protein, weaning off of detrimental grains and improve muscle tone and exercise recovery time in the next issue.

Celiac.com 05/10/2016 - As we all know, traveling with celiac disease can be somewhat challenging. Trying to avoid situations of contamination can be quite difficult, yet we accept this challenge so we can go about a normal routine which in my situation, includes traveling. My wife and I who travel quite often do enjoy a good cruise due to the relaxing atmosphere and great care we receive for my dietary issues. Our experiences on Princess Cruises has been very positive and clearly, they take dietary issues quite seriously.

Unfortunately, not so much with Oceania Cruises. First of all, this experience is based solely on my recent trip. I suspect some other folks with celiac may have had a positive experience. That's great. This article is based solely on how I was treated by this cruise line in August of 2015.

Oceania insists that any request for special diets be submitted by the travel agent. Not sure what happens if you book online.

Once on board, the person in charge of special diet requests met us at dinner and explained we would get a menu in our mailbox every evening. We are to circle our choices and bring it to the desk by 8:30am. We made the mistake of going on a tour and not having it in until noon and guess what? Yup, you order off the menu.

After this discussion, I was directed to dinner choices that could be prepared gluten-free. I was surprised to see my dinner entrée loaded with croutons. O.K., first day shakedown, let's see what happens. Strike 1.

As we all know, buffets can be dangerous but I attempted to try and see if they had any gluten-free foods available. I selected a breakfast item that was clearly battered and asked the server if this was gluten-free. He looked somewhat quizzical and said "yes". Strike 2. I then asked for gluten-free toast. It took a full 15 minutes for them to toast 2 pieces of bread. Strike 3. Later in the cruise, we stopped for lunch at the poolside café where I ordered a sandwich with gluten-free bread. "We don't have gluten-free bread on board" was our waiters' response. After I indicated that was surprising since I have it at dinner nightly, he finally went off and secured my lunch. Strike 4 ?

I could go on and on but I will spare you the rest. Oceania is a high end cruise company with prices to match. Princess on the other hand was exemplary. Once your request is in, you receive an email with a list of gluten-free menu items that will be available. If you want gluten-free beer, this is also offered albeit at a price. Every evening, the maître d comes by so you can order for the next evening. Clearly, they take people with dietary issues seriously.

Why the disparity? I believe it's what I encounter as many restaurants. Since gluten-free dining has become the latest fad diet, I honestly believe that many establishments (and cruise lines) don't feel the need to take proper care. My suspicion is that they just look at gluten-free requests like "oh good, another one of them" and don't take it seriously. I guess my final advice before selecting a cruise would be to see what the initial reaction is to your request. If they respond like Princess, and I suspect other cruise lines, I would at least look carefully at booking a nice vacation. Would I go back to Oceania? I would not. I have put my concerns into writing to them and two months later, no response. My travel agent also followed up about this situation, again, no response.

Traveling with celiac is difficult enough, and I hope that certain companies will begin to take us more seriously.

Celiac.com 05/03/2016 - How do you know when your child has gluten sensitivity, gluten intolerance, or celiac disease? If gluten issues run in your family and you know there is a predisposition to having problems with gluten in foods, then you may be alert to signs that it has been passed on to your child. But if you and your biological family members never had problems with it, then you're not expecting gluten to be an issue. Children arrive with a complicated genetic past that we may not always have the details about. We may not know the health history of the families of our child's other parent, or even sometimes our own. We may not know if anyone had reactions to gluten. Because celiac and gluten sensitivities can appear as chameleons, genes for it may be masked as other health issues. Parents may be a carrier and have no identifiable symptoms at all. People may have celiac disease without ever knowing it.

It's complicated to raise a child. When they don't feel well, it's hard to figure out when their health problems are physical, emotional, social, or psychosomatic. When it comes to kids, having a belly ache is a common occurrence. So are a variety of symptoms that are linked to celiac disease or gluten intolerance or sensitivity, like headaches, fatigue, skin issues, depression, or GI track problems. When are signs pointing at the normal wear-and-tear of growing up—and when they are related to a syndrome like celiac disease? It takes a significant period of observation to figure this out.

Celiac disease is regarded to be an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) found that the prevalence of celiac disease in children between age two-and-a-half and age fifteen ranges from 1 in 80 to 1 in 300 children. This means that in a pediatric practice of 1,500 children there are probably between 5 and 20 children with diagnosed or undiagnosed celiac disease—and potentially a lot more if one adds in gluten intolerance or sensitivities. According to the National Foundation for Celiac Awareness, celiac disease is genetically based, so reactions to gluten are more commonly found in those who have a family history of this autoimmune condition. They collaborated on a multi-phase research project with people diagnosed with celiac disease and at-risk family members who remained untested. Celiac disease was found in 5 to 10 percent of the family members of persons who had been diagnosed with celiac disease. But people may have reactions to gluten yet not have celiac disease. Some may have gluten intolerance or be sensitive to it without being diagnosed with celiac disease, so the actual relationship of health problems potentially associated with gluten may be considerably higher. First and second-degree relatives have more of a risk of developing celiac disease than are more distant relatives. For instance, their research found that celiac disease can occur in about 1 in 22 among children and their parents or siblings. But in analyzing the child's relationship to aunts, uncles, nephews, nieces, cousins, grandparents, half-siblings who may have celiac, the number decreases to 1 in 39. Detailed results of their research can be found from the NFCA's Seriously, Celiac Disease campaign.

In our family, Chris never knew he was predisposed to celiac disease until he hit his twenties. Celiac is sneaky—while it can occur within people at any age, sometimes it doesn't show up until people get a bit older. As a child, he grew up on sandwiches, cookies, macaroni and cheese, and Grandma's home-made bread. When he had a tummy upset, as good mom I'd bring him chicken noodle soup and saltines. I never knew about celiac disease. My family came from a long line of gluten aficionados. As he hit adolescence and his teen years, signs of gluten intolerance emerged, only we didn't know that's what they were. Few parents link together migraines, skin problems with belly upsets and food "allergies." Chris's doctor dismissed his symptoms as independent, routine growing-up conditions without putting all the pieces of the puzzle together to realize that they were actually all a part of a larger celiac syndrome. It was only when he took a road trip and visited his father's sister and his cousins that he learned about the family's predisposition to celiac. His grandma always had stomach problems, I recall. She lived at a time and place where regular folks living in small towns were simply unaware of conditions such as celiac. As the old saw goes, you can't know what you don't know. In hindsight, she clearly had gluten issues. The gene seems to have been latent in her children, but passed on to take more active forms into the next generation of Chris and his cousin. It's confusing, because one child in the family can have a severe case of celiac while a full-blood sibling may have no sign of it at all! If he hadn't taken that road trip and stopped to visit his aunt, he may never have known that he had celiac. Upon that realization, suddenly everything made sense. All of his erratic symptoms were actually a picture-perfect portrayal of someone with celiac disease!

We learned a bit about the disease, went to the store looking for gluten-free foods and quickly began modifying his diet. Since his MD couldn't figure out what was making him feel so bad, and if cutting out gluten could make him feel better, we decided that was a course worth pursuing. He felt better immediately. He has never been officially tested for celiac disease, although that would probably have been a better course of action. At that point in time, we simply didn't know about the testing options.

Testing options have improved significantly over the last decade. The diagnosis of celiac disease can be done with a biopsy of the small intestine mucosa. Blood or serological tests are also helpful but less definitive. The University of Chicago Celiac Disease Center finds that the serum anti-tissue transglutaminase (tTG-IgA) is a widely used antibody blood test for screening for celiac disease, as is a total serum IgA test. The total serum test bolsters the reliability of the tTG test. A newer version of an old anti-gliadin antibody test has been developed called DPG or deamidated gliadin peptides test. Tissue transglutaminase (TTG) measures, endomysial antibody (IgA antibody to endomysium EMA) are recommended by many experts, while formerly used antigliadin antibody tests (AGA) are not as widely used.

About 95% of people with celiac disease have the HLA-DQ2 gene and most of the remaining 5% have the HLA-DQ8 gene. Genetic testing can determine if someone has one or both of these genes. If someone has the gene it means they are at risk of developing celiac disease, but it does not mean that you necessarily have it. A positive genetic test should be followed up with a celiac blood panel to determine if someone has celiac disease. Celiac disease experts recommend family member testing as a proactive approach to diagnosis and then follow up with tests every 2-3 years or if potential symptoms start to emerge. They note that it is possible for someone to initially have a negative test result, but then test positive years later. This is worthwhile to know when trying to figure out if a child has celiac disease or not. It also means that re-testing may be a necessary process, since both the child's body and the disease propensity may change over time.

What are warning signs that a child may have celiac disease? According to the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition and other celiac experts, there are both gastrointestinal and other symptoms to look for—symptoms that one may not logically associate with gluten. But remember that many of these symptoms may exist independently in children and have no relationship to having celiac disease at all! This is what makes trying to figure out whether or not a child has it extremely challenging.

Once a determination is made that a child has celiac disease or is highly predisposed to be gluten intolerant or sensitive, changing the child's exposure to gluten in foods becomes of utmost importance. The problem is, most people aren't aware of gluten issues in general, and they particularly aren't thinking of it occurring in children. As Kay Chick (2014) describes in her article, there are many things that parents and teachers can do to proactively prevent problems in routine situations. She points out that many school cafeterias aren't equipped to safely serve children who have to go gluten-free. Most parents don't realize that making accommodations for children with celiac disease are assured under Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act; seventy-four percent of parents who participated in her study reported their children did not have a 504 plan or written into an Individualized Education Program (IEP) to help everyone make accommodations for their celiac disease. Children with celiac may also be eligible for services under the Individuals Disabilities Education Act (IDEA) if it has an impact on their ability to learn.

Social events like birthday parties, camps, and field trips may expose children to gluten in foods and provide no alternatives for those who can't eat them. Sharing food is a common childhood occurrence, but an experience that leaves celiac kids out unless they are sure the food is safe. Going to another child's house to play or for a sleep-over may be an extra-big deal for a celiac kid. When the team goes out for a pizza party or ice cream cones after a game, the child with celiac has to be extremely careful. It helps enormously when adults and people in supervisory roles understand that when children need to avoid gluten, it is not because it is a choice—it is a health necessity. While a public awareness campaign to help people understand that there are children (and adults) who have to avoid gluten is underway, there's still a long way to go. Children need to learn self-advocacy skills to keep themselves healthy. This is sometimes hard to do when interacting with parents, teachers, and other adults who think that they understand the complications associated with needing to be gluten-free—and they actually don't.

Going gluten-free doesn't have to be hard, but when it comes to children and youth, often it is. From identifying that celiac disease could be a problem, to diagnosing it, to addressing it in one's daily lifestyle, children are a special interest population. In order to help celiac children to live long and healthy lives, it begins with educating adults, most of whom will never have to personally go gluten-free. Speaking out on behalf of a celiac kid is an important thing to do. Adults in all professions need to learn what celiac is and how to institute celiac-safe strategies into their organizations. Even if they aren't affected, adults need to realize how their decisions and behavior may adversely impact children.

Our youngest citizens count on adults to always be looking out for their best interests. Speak with your local schools, recreation groups, and youth-oriented civic organizations to make sure the leaders understand that the chances are high that they are serving children with celiac disease. Help them to understand that they should learn more about what it is, that they should make sure eating arrangements always take into consideration children with special dietary needs, and have food alternatives readily available. Every parent would expect the same concern and attentive care if their child had celiac. And as a community, aren't all children "our" children?

For more information, see our book, Going Gluten Free (Norlights Press 2015). Yvonne Vissing has been appointed by the United Nations to be a Policy Chair for Child Rights, under the UN Convention on the Rights of the Child.

Resources:

1. Chick, Kay. The Educational, Social, and Family Challenges of Children with Celiac Disease: What Parents Should Know. 3/19/2014. Celiac.com
2. Children's Digestive Health and Nutrition Foundation (CDHNF).
3. Diagnosis and Treatment of Celiac Disease in Children. Journal of Pediatric Gastroenterology and Nutrition. 2005; Volume 40, Number 1 (Jan): 1-19.
4. Open Original Shared Link.
5. NOpen Original Shared Link 
6. Raising Our Celiac Kids (ROCK).
7. University of Maryland School of Medicine Center for Celiac Research

Celiac.com 04/26/2016 - Vice President Dan Quayle famously stated: "what a waste it is to lose one's mind, or not to have a mind is being very wasteful, how true that is," when speaking to people involved in the United Negro College Fund (1). While it is entertaining to read and ponder, this statement evokes some ideas I have about senility, which is increasing, along with many other modern diseases, at a frightening speed. The prospect of losing my mind, my memory, my sense of connection with friends and loved-ones, and even my sense of identity and personal hygiene is a frightening spectre. Can you separate your memories and experiences, along with what you think and feel, from who you are? I can't. I'm not sure I would want to be able to do so. My identity is tied to my memories, experiences, and how I responded and continue to respond to them. I remember looking at my son's tiny hands and feet when we first brought him home from the hospital. My daughter, born prematurely, had even smaller digits. They seemed impossibly tiny yet they were all perfectly formed and quite beautiful. It seemed miraculous to me. It still does. I can't imagine anything that I'd be willing to accept in exchange for those memories. Neither would I willingly surrender my memory of the joy I felt at my first convocation or my first car. Yet those lost memories form the prison in which many people already find themselves. It appears that many more will follow.

One segment of this problem, the epidemic of Alzheimer's disease (AD), already effects 5.4 million Americans and 30 million people throughout the world (2). Parkinson's disease, which is a neurological ailment that, in its later stages is often accompanied by dementia, is a similar ailment that is rapidly increasing both in absolute numbers and as a percentage of the population (3). Vascular dementia is yet another condition in which brain mass and mental acuity wane with advancing years (4). Perhaps this trend is partly due to the large number of aging baby boomers from the World War II era. But the relevant research suggests otherwise. Although we may be living longer and that may contribute to a small part of the growth of these devastating ailments, the biggest contributors appear to be lifestyle choices that include low daily activity levels, consumption of highly glycemic and inflammation-promoting refined carbohydrates and grain products, inadequate sleep duration, and exposure to toxic substances.

As most students of celiac disease have long been aware, there is a powerful and potentially devastating component of brain and neurological damage associated with this ailment as a result of gluten grain consumption. In addition to the behavioral changes identified by Gibbons in 1889 (5), attention deficits identified by Reichelt (6), Neiderhofer (7, 8), and others (9 - 11), subsequent reports have connected increased incidence of seizure disorders(12-17), reductions of brain size (17 -20), a variety of neurological movement disorders (21 -23), a range of mood disorders (24, 25), and several psychiatric ailments (26, 27) including schizophrenia (28, 29), and signs of learning disabilities have been reported to improve quite dramatically and quickly on a gluten-free diet (30). Sleep disorders are also common among people with celiac disease (31). With emerging research into non-celiac gluten sensitivity over the last two decades, we have also begun to see evidence of similar connections between gluten consumption and most of these neurological/brain ailments. This added dimension of non celiac gluten sensitivity and its impact on human neurological health, were previously obscure and, in the case of amyotrophic lateral sclerosis (ALS) (26, 32), was thought to be rapidly deadly and incurable (33). Most recently, Bredesen reported that the gluten-free diet, or a low grain diet, forms one significant part of their multi-modal protocol for reversing several dementias among a small group of those who experienced recent symptom onset, including Alzheimer's disease, objectively identified disruptions in memory function or subjective, self-reported symptoms of dementia (2). Of the ten subjects studied in this latter investigation, nine showed substantial recovery in the form of symptom reversal along with either a return to work or improved performance at work (2).

Harnessing the gluten-free diet makes sense, of course, because of the many neurological dimensions of gluten's harmful impact on human neurological tissues. Over the last 20 years, Dr. Marios Hadjivassiliou and colleagues, at the University of Sheffield and the Royal Hallamshire Hospital, have been reporting a wide range of neurological ailments in association with elevated anti-gliadin antibodies ( both with and without celiac disease) afflicting a large portion of their patients with neurological diseases of unknown origin (34 -37). Further, Dr. Joe Murray and colleagues have also reported on a group of thirteen patients experiencing moderate cognitive decline, three of whom experienced stabilized or improved cognitive function on a gluten-free diet alone (38). However, the protocol reported by Bredesen is aimed at correcting a greater number and broader spectrum of converging metabolic processes that are shaped, in large part, by our modern lifestyle, and are increasingly thought to be at the root of the current epidemic of dementias, including Alzheimer's disease (2). Gluten is only an important part of the overall picture. Dr. Suzanne de la Monte and colleagues have also identified a dynamic which they call type 3 diabetes at work in the brains of many patients with Alzheimer's disease (39). Insulin resistance, in the brain and elsewhere, is also a multi-factorial condition (40) which mostly involves disrupted metabolic processes, either through depletion of insulin production or, more likely, increased cellular resistance to insulin's movement of glucose into the cell.

Dr. Dale Bredesen has argued that "in the past decade alone, hundreds of clinical trials have been conducted for AD, at an aggregate cost of billions of dollars, without success. This has led some to question whether the approach taken to drug development for AD is an optimal one" (2) This is the rationale that underlies his enormously broad therapeutic approach employed in his protocol.

Please consider each of the following facets of Bredesen's therapeutic protocol:

1. Serum testing was conducted and subsequent supplement recommendations were made, aimed at improving vitamin, mineral, amino acid, and herb supplements to achieve optimal values. All of the foregoing is aimed at harnessing their putative anti-oxidant function, supporting various facets of metabolism, and making use of their reported anti-inflammatory properties. Chelation therapy was also used to correct heavy metal (mercury, lead, cadmium) toxicity. Non-farmed fish, vegetables, and fruits were emphasized, while meat consumption was either discouraged or patients were encouraged to eat only organic and free range meat.

2. Patients were given their choice of several low glycemic, low inflammatory, low grain diets. By this description, such a diet would exclude or severely limit gluten consumption.

3. Patients were encouraged to engage daily in strategies, including meditation and listening to music, toward reducing their stress levels, which would reduce their cortisol production. Cortisol is a hormone that triggers increased release of glucose into the bloodstream, suppresses the immune system, and inhibits bone formation. In addition to excluding or treating sleep apnea, patients were prescribed melatonin at 0.5 mg daily, toward achieving at least eight hours of sleep each night, thereby reducing production of hunger-inducing ghrelin hormones in the stomach and increasing hunger-suppressing leptin hormones which are produced in the fat cells. Each carries its message to the brain.

Reductions in cortisol and ghrelin secretion in combination with increasing leptin production would have a net effect of reducing inflammation while aiding weight loss and reducing blood glucose levels to normal fasting levels and targeting reduction of hemoglobin A1c levels to below 5.5, further reducing inflammation. Optimum levels of thyroid hormones, along with progesterone and pregnenolone were also pursued, along with reductions of free homocysteine to below 7 mg/L by prescription of vitamin B6, B12, and folic acid supplements, to reduce vascular damage and blockage that can be caused by elevated free homocysteine levels.

Twice daily dietary supplementation with medium chain triglycerides (MCTs) also provides strategy for altering hormone production aimed at improved cognitive function. In humans, medium chain fatty acids resist storage. They must either be converted to ketone bodies in the liver, or rapidly utilized for energy. Because MCTs can induce the liver to increase ketone production, it provides an alternative energy source for many of the brain's cells, without requiring insulin to usher these ketones into the cells, as glucose does. In essence, adequate ketone production provides an alternative fuel both for many brain and other cells throughout the body. The liver mostly produces the ketone called beta-hydroxybutyrate. This acts not only as a fuel source, but is also a powerful anti-oxidant that does not require insulin to enter the cell, unlike vitamin C, which does require insulin to enter cells.

4. To further promote these values and other facets of wellness arising out of regular activity, patients were asked to exercise for 30 to 60 minutes per day, 4 to 6 days each week.

Each and all of the above have been reported somewhere in the literature as valid and valuable as part of reversing dementias, which Bredesen's list of citations supports (2). However, while significant improvements in the dementia symptoms of nine of the ten subjects does argue for the validity of this protocol, wholesale acceptance of all of the concepts here would fail to narrow our focus on those factors that are most likely to contribute to causing the vast majority of the various dementias that are contributing to the emerging epidemic. Bredesen also acknowledges that study participants were encouraged to follow as many instructions as they could. They were not asked or expected to be fully compliant with the instructions they were given. Nonetheless, I would probably err on the side of caution, by implementing as many of these strategies as possible, were I dealing with a loved-one who struggled with dementia.
Conversely, I would be most reluctant to accept the interdiction of meats, organic or otherwise. On the other hand, growth promotion using low doses of anti-biotics can result in delivering anti-biotic resistant microbes. Poultry, hogs, and cattle are all high risk meats. Further, grains, especially gluten grains and corn, combine to form the mainstay of feeds used to fatten these animals and birds for market, where weight is the determining factor in the price paid for these meats.

Bredesen also pointed, quite rightly, to the small number of subjects as a weakness in his study. However, when 9 of their 10 subjects achieved such remarkable results, especially in the context of the common belief that dementia, at any stage, is irreversible, this study certainly suggests that exploring dementias as a group of metabolic illnesses is a potentially fruitful path.

This is a perspective that is enjoying considerable support from a variety of sources. Many researchers have, for the past decade or so, thought of many dementias as type 3 diabetes, with a growing body of support for this perspective amassing in the peer reviewed literature (41). More recently, chronic sleep deprivation has been similarly implicated in several ways. The first is specific to Alzheimer's disease, where beta amyloid deposits or plaques characterize this ailment. New research has shown that during sleep, brain tissues shrink, while the fluids that surround the brain permeate these tissues and inter-cellular structures, assimilating amyloid, which is a group of protein fragments (peptides) that are waste products of daytime brain cell activities (42). Because there is no lymphatic system in the brain, it has long been believed that the brain did not dispose of its waste products. However, another field of brain research has shown that conduits of these fluids form surrounding the blood vessels, carrying waste products into the bloodstream and, ultimately, out of the brain for disposal (42). Since average nightly sleep duration has shortened from nine hours to seven hours, given the above research findings, this reduction in sleep decreases our nightly capacity to remove waste amyloid and other detritus, leading to the formation and growth of amyloid deposits, which characterize at least one form of dementia.

This same culture-wide sleep deprivation also induces memory disturbances and memory losses. It does so by a circuitous route. Throughout the day, each of us encodes memories through our hippocampus, a small region of the brain that is also involved in spatial navigation and contributes, with other parts of the lymbic system, to the regulation of many body functions. During sleep, the day's memories are thought to be processed and integrated with prior knowledge, emotions, and impressions in the neo-cortex. Some researchers are now postulating that this integration process is what results in our dreams (43-45). Regardless of whether it is the author of our dreams, Dr. Robert Stickgold and colleagues have shown that sleep helps us to consolidate the day's learning experiences, thus improving our memory retention. He has also shown that inadequate sleep compromises learning (43). The net result is that we not only need sleep to permit the brain to clean out the day's wastes, we also need it to form and preserve learning.

Although Bredesen made no mention of it, there is another complicating factor here. Statin drugs are aimed at reducing cholesterol. However, they have also been shown to induce memory problems. One friend of mine was prescribed a statin drug, and he stopped being able to recognize me. After discontinuing this medication, he told me that I looked familiar, but he couldn't even guess at my name or where he knew me from. He waves hello to me from across the street, but doesn't cross it to visit anymore. And that seems to be where the recovery of his memory is stalled. It is with heart-rending sadness that I occasionally see him in passing. I say hello. But if he doesn't notice me waving or hear me shouting, there isn't even an exchange of greetings. He seems happy enough. So perhaps the loss is mostly mine. But I don't imagine that he would willingly have chosen this "new" world of his.

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Celiac.com 04/20/2016 - I am likely to be accused of gluten heresy. That is because I propose that celiac disease and gluten sensitivity usually coexist. By this I mean that they are not mutually exclusive entities.

In other words, most people who have celiac disease are also gluten-sensitive. Many people who are gluten-sensitive are likely to develop celiac disease with continued gluten exposure (depending on their genetic markers).

My observations show that the distinction between celiac disease and gluten-sensitivity (the gluten syndrome) is blurred. The purpose of published algorithms and decision trees are designed to separate out celiac disease from other gluten-illnesses. I suggest that this thinking is flawed.

For example, most flow charts go something like this: (See Flow Chart 1 at left).

People are selected for celiac-blood-tests for a number of reasons. If your blood tests are positive (and usually if you carry a DQ2/8 gene), then you get an endoscopy to confirm/deny the diagnosis. This allows you to be categorized either Yes-celiac disease or Not-celiac disease. There is no overlap. This is an "us-and-them" scenario.

However, isolating YES-celiac disease from every other gluten problem does not take into account that people who have gluten-gut-damage may well have other manifestations of gluten-related disorders.

Such simplistic algorithms (decision trees) strike problems at every decision point. Such as: Who should be tested? Who should be re-tested? When should these tests be done? At what age? On how much gluten? What tests should be done? What are the cut-off levels? How important is carrying the DQ2/8 genes? What about sero-negative celiac disease? How accurate are endoscopic biopsies? Who interprets the Marsh scale? How long should a gluten challenge be?

Such simplistic algorithms (decision trees) also do not give satisfactory answers to the following questions:

1. Why do 10% of people with celiac disease have little or no symptoms, despite having severe small bowel damage (villous atrophy)? This group is called "asymptomatic" celiac disease. Villous atrophy alone cannot account for the majority of gluten-related symptoms.
2. Why do half of the people with celiac disease have autonomic nervous system dysfunction? This is the disturbance of the automatic nerve activity of your internal organs. This cannot be directly attributed to villous atrophy.
3. Why do most people with celiac disease have some brain/mental upset, including the pervasive brain-fog? Many people have neurological disease from gluten but do not have established celiac disease.
4. How can so many "extra-intestinal manifestations" of celiac disease be attributed to intestinal gut damage alone?

I am sure that you will have witnessed strong feelings from the defenders of 'celiac-disease-is-a-stand-alone illness'. For instance, read these two opposing comments from Facebook:

• A. "I find it hard to believe that gluten intolerant people (or gluten avoiders) are as strict as us who have celiac disease."
• B. "I am gluten intolerant (suspected Celiac but I refuse to eat gluten in order to be tested properly) … I am incredibly strict on what I eat."

The world of gluten is not black and white! But there remains a tension between those who have "biopsy-proven" celiac disease, and those people who are "gluten-intolerant". However, there is a cross-over between gluten-sensitivity/intolerance and celiac disease. There is no sharp dividing line – there is lots of grey!

I would like to see the support groups of both celiac disease and gluten sensitivity work together with a focus on their common ground. This is already happening in some countries. Both groups promote an accurate diagnosis and a strict gluten-free diet. But I call into question the accuracy of current diagnostic methodology.

Another comment from Facebook is a good example of these blurred lines:
"I had an endoscopy and I have some small intestine damage: increased intraepithelial lymphocytes, shortened villi and duodenitis. The gastroenterologist said I had gluten-sensitivity but because I was not celiac (wasn't Marsh stage 3a), he said that I didn't need to be quite as careful with gluten. But I know I am super sensitive - even a small piece of chocolate with gluten in it makes me sick for a few weeks. I suspect that I either didn't have enough gluten before the endoscopy, or I am in the early stages of developing it."

This is what I conclude:

1. Both groups (people with celiac disease, and people with gluten sensitivity/intolerance) come under the umbrella category of gluten-related disorders. The term non-celiac gluten-sensitivity (NCGS) excludes those with evidence of intestinal damage from gluten. But with time and continued gluten ingestion, some of these people will develop celiac disease. NCGS is part of the gluten-related disorders spectrum (see my book: Open Original Shared Link).
2. Both groups have an identical list of possible symptoms. They are both equally harmed by gluten. They are indistinguishable from each other without blood tests and/or endoscopy.
3. For both groups, my recommendation is to be zero gluten. Avoidance of cross-contamination is crucial for everyone. Both groups can be exquisitely sensitive to gluten. Some celiacs experience no symptoms from gluten, making it more of a challenge for them to remain gluten-zero. Some gluten-sensitive people do not yet have overt symptoms but are developing an inflammatory state.
4. Many people who are gluten-sensitive produce antibodies to gluten, AGA (anti-gliadin-antibodies). There is a large literature on this. AGA-positive people are more likely to develop gluten-illnesses. AGA tests are recommended in the Fasano paper the "spectrum of gluten related disorders", for the celiac and gluten sensitivity work-up (particularly for neurological disorders). I use them on a day-to-day basis in my Clinic, and so do many other practitioners. More wheat/gluten harmful proteins have yet to be identified. Early in the development of celiac disease, the person can have significant symptoms, and they may have elevated AGA antibodies, but they may have no evidence yet of intestinal damage. At this stage these two conditions are indistinguishable.
5. How early can you diagnose celiac disease? Do you have to wait until there is substantial intestinal damage so that you can make the classic diagnosis with villous atrophy? Or do you keep on eating gluten until the damage has occurred? Or do you go strictly gluten zero and not know if you are gluten sensitive or have early celiac disease? The HLA gene (DQ2/DQ8) cannot be used as a casting vote. It is my recommendation to abandon gluten as early as possible and not wait until you have substantial intestinal damage, which may never heal.
6. Not only is the gluten intolerant community (this includes celiac disease) confused about gluten-illness. Also, the medical fraternity is confused. The science and clinical issues are rapidly developing whilst most medical practitioners are still looking for the classic celiac with weight loss, malabsorption, and a bloated tummy (and are using an out-of-date simplistic algorithm). Many people request celiac tests of their GPs but are denied the test. The community is much more aware of gluten related disorder than medical practitioners.

Yes, there are a lot of issues to think about. These gluten-illnesses are complicated to diagnose. My prediction is that increasing numbers of people will adopt a gluten zero diet. However, almost certainly it is much more than the substance gluten that is making us sick. It will take a long time to unravel all of these strings. Most people are after an easy answer, or a drug, or a vaccine. But I'm sure that it is going to become even more complicated as we learn more. These complexities do not show up in a simplistic algorithm.

The way for an individual to solve this is to adopt a gluten-zero diet, lifelong.